The effect of suturing on force for dislodgement of tracheostomy tubes

Comparing the tracheostomy dislodgement and complication rate of non-sutured neck tie to skin sutured neck tie fixation

INTRODUCTION

Tracheostomy management is a routine aspect of care in the critical care setting. While there are multiple complications that can arise in the post-operative setting after creation of a tracheostomy, dislodgement of a tracheostomy tube is associated with high mortality requiring rapid intervention. It is therefore important to prevent the occurrence with proper securement of the tracheostomy. In this study, we look at two methods commonly used to secure tracheostomy tubes: suturing of the lateral flanges to the skin with the use of cloth neck ties versus cloth neck ties alone.

METHODS

This is a retrospective study with data collected from 1355 consecutive tracheostomy cases at a single institution. Our institution serves the County of San Bernardino, California as a level II trauma center. Patient selection occurred between 2004 and 2018, with distribution of patients to skin-sutured with neck tie tracheostomies (ST) and non-sutured neck tied only tracheostomies (NST) groups occurring by date of tracheostomy surgery. Our study investigates the dislodgement rate of percutaneous tracheostomies secured by either of these two methods. Due to a greater morbidity of tracheostomy dislodgement before a mature fistula tract is formed, we were specifically interested in the dislodgement rate within 7 days.

RESULTS

In total, 328 cases of NST and 1027 cases of ST were collected. Overall, there was no statistically significant difference regarding the dislodgement and accidental decannulation rate between NST and ST (2.32% vs 4.46% for NST and ST, respectively, p = 0.1476). There was also no statistically significant difference regarding rates of dislodgement and accidental decannulation within 7 days between NST and ST (1.54% vs 1.11% for NST and ST, respectively, p = 0.5608).

DISCUSSION

It takes 5-7 days for a tracheostomy tract to mature, and therefore most dislodgement occurs perioperatively within the first week after placement. Dislodgement of the tracheostomy tube can lead to devastating complications for those patients. To our knowledge, there has been no study investigating dislodgement in the early post-operative period in relation to tracheostomy securement method.

CONCLUSION

Due to the emergent nature of tracheostomy dislodgement and loss of airway, prevention of this complication is critical. Our investigation found no statistically significant difference in the rate of early tracheostomy dislodgement in the skin sutured with neck tie and non-sutured neck tie only groups. This study contributes further data to the available literature regarding tracheostomy securement methods and dislodgement rate, specifically within the early post-operative period.

LEVEL OF EVIDENCE

2b.

An animal tissue simulation assessing three directional displacement forces on five common tracheostomy securing techniques

Introduction Several methods of securing a tracheostomy tube have been described in the literature including using ties or tapes around the neck and suturing the plastic flange to the neck in various ways. However, there are no wet lab-based studies to objectively determine the force required to displace the tracheostomy tube using different securing techniques. Ours is the first animal tissue simulation study published in the literature. Methods A simulated tracheostomy stoma was created on a sheep neck model. A tracheostomy tube was inserted into the stoma and secured using various methods. Tension tests were conducted to significantly displace the tube from the stoma. Each technique was repeated six times on different sheep necks. All results were analysed using SPSS®. Results Repeat measurements indicated that the largest displacement forces come from an oblique direction while the lowest force values were found at the lateral angle. Averages of displacement showed that medially placed sutures required the largest forces in comparison with other securing methods. Wilcoxon signed-rank testing indicated that medial and continuous suture security resists displacement at forces that otherwise displace flange and interrupted sutures. Conclusions This study has shown that any type of securing suture requires a greater displacement force than the strap of the tracheostomy tube holder alone. Medially placed sutures require a greater displacement force than those placed laterally. Displacement in the lateral direction requires the least force in comparison with movement at perpendicular or oblique angles.